Texas leaders split on health care ruling outcome, costs

AUSTIN — Any day now the United States Supreme Court is expected to rule on the constitutionality of the Patient Protection and Affordable Care Act, the landmark legislation the then-Democrat-controlled Congress passed two years ago and President Barack Obama signed into law.

In the long history of the high court, few rulings have been as anticipated as this one.

And in Texas — one of 26 states that challenged the legality of the law critics call Obamacare — no one wants to see the act overturned more than state Attorney General Greg Abbott, Gov. Rick Perry and leaders of the state’s Republican-dominated Legislature.

“Understand this,” Abbott said in a recent video the conservative group Empower Texans posted on YouTube. “Our lawsuit was not about health care, out lawsuit was not about health insurance.

“Instead, our lawsuit was about an unprecedented mandate issued by the United States Congress and signed into law by Barack Obama,” Abbott said. “This is a mandate that compels all Americans to purchase a product, whether you want it or not … first time in American history this has happened.”

Based on three days of oral arguments in late March, Abbott, Perry and legislative leaders expect the court to strike down at least the individual mandate that requires nearly all Americans to carry health insurance.

Some state officials say don’t be too sure. In their opinion, Texas also should be prepared for the possibility the law, or at least its main components, might be upheld.

“We want to make sure health care and health insurance goes on uninterrupted,” Rep. John Smithee, R-Amarillo, said at a joint hearing the House Insurance Committee he chairs and the chamber’s Public Health Committee held to discuss how Texas must deal with the law, regardless of how the court rules.

As an attorney, he thinks the majority of the nine justices will rule in favor of Texas and the other states that filed the lawsuit, Smithee said in an interview.

But as a legislator, he is keeping his fingers crossed because Supreme Court rulings are hard to predict.

“All of us hope that the court strikes down the law because we don’t have the money,” he said.

“It would be impossible for Texas to fund Medicaid because of our population growth.”

If the law is upheld, Texas would add 1.2 million people to its Medicaid program when it goes into full effect in 2014, Katrina Daniel, associate commissioner at the Texas Department of Insurance, said at the joint hearing.

This would bring total enrollment to 4.7 million, or about 20 percent of the state’s current population.

From there it would get more complicated for the Legislature and for officials overseeing health- related agencies and programs.

Texas A&M University economist Thomas Saving told the lawmakers that in 2010, the state’s share of the Medicaid program was about 34 percent, but it’ll soon be about 40 percent.

“It’s going to increase significantly,” Saving said.

State Medicaid director Billy Millwee explained what such an increase would mean to Texas.

About 26 percent of the state’s population is uninsured, Millwee said.

If the court upholds the act, the percentage of Texans with no health coverage would drop to about 9 percent.

Put another way, the percentage of Texans with health insurance would rise from 74 percent to 91 percent if the high court upholds the constitutionality of the federal health care law, and this in turn would increase the state’s costs, mainly for Medicaid coverage.

The state has the highest percentage of uninsured people in the nation.

So, money is the big dilemma the Legislature would face if the Supreme Court upholds the legality of the Affordable Care Act, Smithee and other state officials said.

“How are we going to pay for it?” Smithee asked. “We’re already taxing people too much and a state income tax is not politically possible.”

However, Democrats said those concerns are unfounded.

“The Affordable Care Act basically pays for Medicaid for the first three years and after that it’s a nine-tenths match,” said Houston’s Rep. Garnet Coleman, a leading health care expert in the Legislature.

This means that after three years Texas would pay 10 cents for every dollar of Medicaid costs, Coleman said.

“What we have to remember is that my Republican colleagues don’t believe the state should spend any money on health care for people,” he said.

“With the Affordable Care Act, Texans benefit because we have the highest rate of uninsured in the nation and the highest number of uninsured people, too.”

Insurance companies would no longer be able to deny health coverage to diabetics or to people with cancer or any other disease, Coleman said.

“Under the Affordable Care Act you can get insurance, even if you have a pre-existing condition,” he said.